Predictors of Decision Regret among Caregivers of Older Canadians Receiving Home Care: A Cross-Sectional Online Survey

Abstract

Background. In Canada, caregivers of older adults receiving home care face difficult decisions that may lead to decision regret. We assessed difficult decisions and decision regret among caregivers of older adults receiving home care services and factors associated with decision regret. Methods. From March 13 to 30, 2020, at the outbreak of the COVID-19 pandemic, we conducted an online survey with caregivers of older adults receiving home care in the 10 Canadian provinces. We distributed a self-administered questionnaire through Canada’s largest and most representative private online panel. We identified types of difficult health-related decisions faced in the past year and their frequency and evaluated decision regret using the Decision Regret Scale (DRS), scored from 0 to 100. We performed descriptive statistics as well as bivariable and multivariable linear regression to identify factors predicting decision regret. Results. Among 932 participants, the mean age was 42.2 y (SD = 15.6 y), and 58.4% were male. The most frequently reported difficult decisions were regarding housing and safety (75.1%). The mean DRS score was 28.8/100 (SD = 8.6). Factors associated with less decision regret included higher caregiver age, involvement of other family members in the decision-making process, wanting to receive information about the options, and considering organizations interested in the decision topic and health care professionals as trustworthy sources of information (all P < 0.001). Factors associated with more decision regret included mismatch between the caregiver’s preferred option and the decision made, the involvement of spouses in the decision-making process, higher decisional conflict, and higher burden of care (all P < 0.001). Discussion. Decisions about housing and safety were the difficult decisions most frequently encountered by caregivers of older adults in this survey. Our results will inform future decision support interventions. Highlights This is one of the first studies to assess decision regret among caregivers of older adults receiving home and community care services and to identify their most frequent difficult decisions. Difficult decisions were most frequently about housing and safety. Most caregivers of older adults in all 10 provinces of Canada experienced decision regret. Factors associated with less decision regret included higher caregiver age, the involvement of other family members in the decision-making process, wanting to receive information about the options, considering organizations interested in the decision topic, and health care professionals as trustworthy sources of information. Factors associated with more decision regret included mismatch between the caregiver’s preferred option and the decision made, the involvement of spouses in the decision-making process, higher decisional conflict, and higher burden of care.

Canadian Older Adults’ Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey

“…Comparing older adults’ and caregivers’ preferences could allow for a better understanding of each point of view and their respective needs, values, and priorities. This would better prepare older adults and their families for SDM discussions with each other and with their health professionals (eg, doctors, social workers, physiotherapists, and occupational therapists) and reduce the decisional regrets of older adults [ 11 ] and caregivers [ 10 ]. The eDA could thus be a useful tool in the implementation of an interprofessional SDM model, which stresses the importance of facilitating communication between different parties involved in the SDM process to reach common ground about the issues at stake, especially when it comes to sensitive topics such as housing decisions [ 55 , 56 ].…”

“…Second, our results suggest that older adults who are supported in their decision-making process by their family, friends, and health care team are more inclined to use the eDA to make housing decisions. Other studies have confirmed the importance of relatives in the decision-making process regarding housing options [10,11]. Therefore, it could be useful to add a section in the eDA to be filled in by caregivers who are involved in the decision.…”

“…In Canada, housing decisions are considered the most frequent and difficult decisions for older adults receiving home care as well as for their caregivers [ 10 , 11 ]. The Ottawa Decision Framework identifies the factors influencing decisions as, in general, inadequate support and resources (or “decisional needs”) as well as personal characteristics such as gender, education, and ethnicity.…”

Decisional support needed when facing tough decisions: Survey of parents with children having differences of sex development

“…The Decision-Making Preference scale assesses the degree of control desired in decision-making using a 5-point response scale, ranging from complete patient/parent control, through collaborative control, to complete healthcare provider control (34). The Decision Regret scale is a 5-item questionnaire; alpha coefficients range from 0.81 to 0.92; scale scores correlate with decision satisfaction (r's=0.40 to -0.60) and decisional conflict (r's = 0.31 to 0.52) (35); scores range from 0 to 100, with 0 indicating no decision regret, 1-25 mild regret, and >25 moderate to strong regret (36,37).…”

Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys

“…Adapted from previous surveys in Canada [13,14,27], questions were based on the Ottawa Decision Support Framework [11].…”